Provider Demographics
NPI:1497278782
Name:JEA EARLY INTERVENTION SERVICES
Entity Type:Organization
Organization Name:JEA EARLY INTERVENTION SERVICES
Other - Org Name:JEA EARLY INTERVENTION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL ED TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-288-5753
Mailing Address - Street 1:9346 215TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1708
Mailing Address - Country:US
Mailing Address - Phone:917-288-5753
Mailing Address - Fax:
Practice Address - Street 1:93-46 215 STREET
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428
Practice Address - Country:US
Practice Address - Phone:917-288-5753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTF-3534719252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency